Recent snap poll released by NOIPolls has revealed that almost 9 in 10 adult Nigerians (89 percent) pay out of pocket for health care services, as they do not have any form of health insurance. This finding is contrary to the main objective of the National Health Insurance Scheme (NHIS) aimed at securing universal health coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians.
In line with this, the Executive Director of NHIS, Prof. Usman Yusuf, speaking during the opening ceremony of a two-day retreat for directors of National Orientation Agency (NOA) and the NHIS in Abuja in November 2016, stressed that ‘the NHIS has expressed sadness over its inability to have majority of Nigerians covered under its healthcare policy, many years after its inception’. He further stated that ‘there is an urgent need for the scheme to reach out and extend coverage to more Nigerians especially at the grassroots’. .
More findings revealed that only 9 percent of the respondents claimed they have some form of health insurance, of which 71 percent indicated NHIS and 21 percent indicated Private Health Management Organizations (HMOs) as their provider. While insurance cover for all Nigerians is still a far cry from the industry’s expectation, on the bright side, a significant proportion of Nigerians (78 percent) who are currently not covered expressed willingness to pay a small amount of money monthly/yearly to get enrolled for health coverage. Interestingly, this finding highlights a critical low hanging fruit for stakeholders in the health sector, as part of a wider range of solutions to broadening the pool of funds and achieving more sustainable health financing and coverage for all Nigerians. Finally, it is also pertinent for all stakeholders within the health sector, particularly NHIS, HMOs, Hospitals, CBOs and FBOs to engage in mass mobilisation of the general public, especially the poor and vulnerable, to leverage on the benefits of health insurance. These are the key findings from the Health Insurance Snap Poll conducted by NOIPolls in the week of August 1st 2017.
Health service delivery in Nigeria has been inundated with various policies and plans from different administrations. Nigeria’s healthcare delivery system includes a vast number of private and public health providers who have vital roles to play within the sector. Different modalities of free health services have been adopted by the various tiers of government at different times.
The National Health Insurance Scheme (NHIS) was established in 1999 as a major factor in the National Poverty Eradication Efforts, to improve the health status of Nigerians. The scheme which was officially launched in 2005, aims to provide health insurance to citizens so that insured individuals and their wards have access to good, quality and cost-effective healthcare services. Some of its objectives are to protect families from the financial hardship of huge medical bills, to ensure equitable distribution of healthcare costs among different income groups, to ensure high-standard and efficiency of healthcare delivery and services to Nigerians and to ensure the availability of funds to the health sector for improved services; amongst others.
Similarly, Health Maintenance Organisations (HMOs) were established to ensure the overall success of the NHIS by facilitating affordable and high quality Medicare for Nigerians. In order to ensure that all segments of the society are covered, such as the formal sector, self-employed and rural community, children under five, the disabled, prison inmates, tertiary institutions and armed forces, the NHIS developed various programmes to reach these areas. In June of 2017, the Federal Ministry of Health stated that the HMOs had recorded abysmal failure in the health coverage of Nigerians which has resulted in many avoidable deaths. Against this background, NOIPolls conducted a survey in order to gauge the perception of Nigerians regarding health insurance in the country.
In order to ascertain the most utilized healthcare facilities by Nigerians, respondents were asked to identify their primary source of health care services when they or their family member fall ill. Interestingly, the findings revealed that majority of Nigerians (63 percent) say they visit government owned hospitals (primary, secondary and tertiary health facilities). During the course of this poll some of the respondents in this category disclosed that they prefer government hospitals because they get subsidized charges and that they have the chance to be examined by consultants who are usually senior grade medical doctors. This was followed by respondents who visit private hospitals (39 percent) and Pharmacy/Chemist stores (17 percent), and those who self-medicate (13 percent) amongst others.
In order to probe further, when asked how they pay for healthcare services, majority of the respondents (82 percent) reported that they pay “Out of pocket”, and this cuts across gender, geo-political zones and age groups. Further, analysis indicated that a total of 89 percent actually pay out of pocket, since 7 percent of respondents said they received support from friends and family, which can also be categorised as out of pocket expenses. This was followed in a far distance by only 9 percent of the respondents who claimed that they access health care services using their health insurance scheme. This finding clearly highlights the low penetration of health insurance amongst the populace, which urgently needs to be bridged in order to achieve universal health coverage.
Moving on, poll also ascertained the willingness of Nigerians who currently pay out of pocket to pay a small amount of money monthly or yearly (premium) in order to access healthcare services when they need it, especially in time of emergency. In response, almost 8 in 10 (78 percent) respondents expressed their willingness to pay a small amount to get enrolled into the health insurance scheme. Interestingly, during the course of the poll, some respondents made on the spot inquiries on how to enrol on a health insurance scheme. These findings clearly demonstrate the critical need for sensitization and awareness campaigns to mobilize the citizenry on the need and benefits of health insurance.
In conclusion, the poll revealed that most Nigerians (89 percent) do not have any form of health insurance, thus they pay out of pockets to access healthcare services; and of this proportion, 78 percent expressed their willingness to pay a small amount of money to enable them access service whenever they fall ill. These findings clearly highlight the low penetration of health insurance across the country and calls for intensive sensitization and mass mobilisation of the populace. Finally, while it is critical for government to re-evaluate its current budgetary allocation to the health sector; it is also important for stakeholders to consider more sustainable ways to finance of the sector through health insurance, and to mobilise the public to increase the pool of funds available for investment into the sector.